A neuroma is a progressive degenerative enlargement of a nerve that is often associated with severe lancinating pain and cramping. Neuroma pain can become debilitating, limiting patients' physical activities in daily life, and severely limiting their quality of life. In extreme cases, patients may be forced to use crutches to move about. Neuroma formation in the lower extremity is one of the most common causes of foot and ankle pain encountered by foot and ankle surgeons.
It is estimated that up to 8 million people in North America may suffer from a Morton's neuroma. A Morton's neuroma is a neuroma created in the foot, between the bones of adjacent toes, most commonly between the third and fourth toes, but also commonly between the second and third toes. The neuroma can be caused by bones rubbing together repeatedly around the nerve, or by abrasion of the nerve by the ligament.
Current treatments for Morton's neuroma include:
(a) Accommodative orthotics (custom shoe inserts) for adjusting the structural support for the foot to reduce nerve irritation. The effect of such treatment is relatively modest;
(b) Pain relief injections, for example, non-steroidal anti-inflammatories and corticosteroid injections. These can be more effective than accommodative orthotics, but the effectiveness may be reduced by repeated injections, and injections are commonly ineffective for severe neuromas;(c) Surgical excision of the neuroma. This requires an invasive surgical procedure, supervised by an anaesthetist, and involving the risks associated with any surgery. The treatment is relatively expensive, and is normally reserved for patients who fail to respond to the foregoing treatments. After the procedure, the patient is disabled during recovery for a period of three to six weeks. Moreover, the failure rate of surgical neurectomies exceeds 20%. It is not uncommon for a neuroma (a traumatic amputation or “stump” neuroma) to reoccur at the point of excision of the inciting neuroma. Such a recurring neuroma often has the same or worse debilitating pain symptomatology as the inciting neuroma, and may require further surgery.
Another common, and painful, foot problem is plantar fasciitis, caused by deterioration of the plantar fascia in the foot. It is estimated that up to 40 million people may be affected by such a problem.